More questions on Trump’s mental health

February 2406:362017

By Lee Siegel

Just about every week, the media invites a psychiatrist or psychologist to admonish other psychiatrists or psychologists for calling Donald Trump mentally ill. This has become the default recourse when it comes to the question of Trump’s mental health for a media relentlessly accused of being partisan, “fake,” and deliberately dishonest.

But leaving the question of Trump’s mental condition to a group of professionals is an avoidance strategy that is becoming more transparently irresponsible by the day.

Since Trump declared his intention to run for president, there has been speculation on his mental state. Terms like “narcissistic personality disorder” and “borderline personality” began to appear more and more frequently in references to him, both in the press, and in the words of his opponents and their proxies.

For journalists, the conflict over how and whether to address the issue is growing with every one of Trump’s outbursts. At what point do the news pages (in addition to the opinion pages) weigh in? Is there a danger of trivializing mental-health issues through armchair commentary? Is this even a useful storyline, given that the president’s true mental state is essentially unknowable to any outsider, not least reporters?

The journalistic conflict came to a head about a week ago with the publication, on two consecutive days, of two letters in The New York Times. The first, written by two psychiatrists and signed by, as the Times stated, “33 other psychiatrists, psychologists and social workers,” began by attributing the “silence from the country’s mental health organizations”—and by implication, the media where these organizations could make themselves heard—to the “American Psychiatric Association’s 1973 Goldwater rule,” an edict that must have been as obscure to other readers as it was to me. This rule, the letter explained, prohibited the psychological evaluation of public figures.

The decree came in response to a survey published during the presidential election in 1964 by Fact, a muckraking magazine published by Ralph Ginzburg, known for his legendary run-ins with the Supreme Court over the issue of obscenity. Fact asked 12,356 psychiatrists if they believed Senator Goldwater was “psychologically fit” to be president. Of the 2,417 people who responded, 1,189 said that they believed Goldwater was not. Goldwater successfully sued Ginzburg on defamation charges, the suit eventually reaching the Supreme Court, which refused to overturn the lower court’s decision.

Alarmed by the incident, the APA concluded that such speculation about a politician’s mental health by mental health professionals who had not examined him or her was “irresponsible, potentially stigmatizing, and definitely unethical.” The APA then published the Goldwater Rule as an annotation in a book called the “Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry.” The organization feared that such speculation would make the public lose faith in the profession. The authors and signatories of the letter that appeared in the Times disagreed. They argued that “too much is at stake to be silent any longer.”

The next day, another psychiatrist named Allen Frances, the chairman of the task force that compiled the “Diagnostic and Statistical Manual of Mental Disorders IV—the diagnostic bible of the psychiatric profession—laid into the previous letter. He lamented “fevered media speculation” that has “encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance.”

Frances explained that he “wrote the criteria that define narcissistic personality disorder,” the condition some mental health professionals, and journalists, have said they believe Trump suffers from. But, Frances asserts, Trump does not meet those criteria “because he does not suffer from the distress and impairment required to diagnose mental disorder.” He goes on to argue that:

“Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither)”

Frances concludes his argument that no mental health professional who has not examined Trump should be allowed to publicly say what he thinks Trump’s psychological motivations might be by declaring that Trump’s “psychological motivations are too obvious to be interesting.” A few days later, a Times writer on mental health issues, Richard Friedman, concurred, also citing the Goldwater rule and adding his own new wrinkle: judging Trump mentally ill would let him “off the moral hook.”

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Six and a half years ago, the Times entered this morass, in a Sunday Review piece speculating about the mental state of former president Obama. Drew Westen, a professor of psychology at Emory University, wrote about what he saw as Obama’s passivity, a trait that progressives and some liberals had loudly complained about. Calling it a “character defect,” Westen speculated that Obama suffered from a “deep-seated aversion to conflict,” was caught in a “pattern of presenting inconsistent positions with no apparent recognition of their incoherence,” and displayed “tic-like gestures of compromise.” He finished his essay by stating that Obama did not “know who he is and what he believes in.”

There was indeed an outcry against Westen for presuming to speculate about Obama’s state of mind—though Westen hid the term “psychology” in the folds of the word “character.” It is quaint now, almost surreal, to think of Obama as mentally unfit to be president. But at the time, Westen’s essay, for all the anger and indignation it provoked in some quarters, was accepted as part of the legitimate democratic discourse about a president’s state of mind and motives.

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It was the sociologist Christopher Lasch who made the term and the clinical condition “narcissism” famous when he published his bestselling 1979 book, The Culture of Narcissism: American Life in an Age of Diminishing Expectations. Lasch argued that a host of economic factors, especially rampant consumerism, had converged to make people self-obsessed and self-loathing, hyper-competitive and afraid of competition, cut off from reality, erratic, unempathetic, angry, vindictive. Recent arguments that the stock market’s unprecedented gains are proof of the business community’s faith in Trump, and therefore evidence of his mental fitness, would have made Lasch smile.

There are plenty of flaws in Lasch’s jeremiad, as there are in any set of sweeping generalizations about a society. But many of Lasch’s perceptions could just as well have been written yesterday. As a result of people disappearing into their own psyches, radically estranged from other people and from social norms, “truth has given way to credibility, facts to statements that sound authoritative without conveying any authoritative information.” Rival commercial claims for a product have the general effect of “[blurring] the distinction between truth and falsehood in a fog of plausibility.” (To drive home his point, Lasch cites the example of Nixon’s press secretary, Ron Ziegler, who at one point “admitted that his previous statements on Watergate had become ‘inoperative.’”)

Lasch’s most prescient insights are about individual character. The narcissistic personality, Lasch wrote, will “display… the prevailing obsession with celebrity and a determination to achieve it even at the cost of rational self-interest and personal safety. The narcissist divides society into two groups: the rich, great, and famous on the one hand, and the common herd on the other. … [Narcissists] worship heroes only to turn against them when their heroes disappoint them. … The narcissist admires and identifies himself with ‘winners’ out of his fear of being labeled a loser. … his admiration often turns to hatred if the object of his attachment does something to remind him of his own insignificance.” Lasch did not allow himself to get lost in pondering the question of whether narcissistic personality disorder should be considered mental illness. For Lasch, a person possessing such traits was able to function on various levels of practical endeavor, but unable to function as a rational or trustworthy member of society; that is to say, as a human being capable of kindness, empathy and attentiveness to others people’s reality. And Lasch was not even talking about presidents.

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Up to now, Trump’s behavior has been analyzed as political inexperience, everyday insecurity, lack of attention span, calculated disruption, autocratic eruptions—even relished as a type of diversion that can be satirized by comedians. Whenever the question of his mental fitness is explicitly raised, the professionals are brought in to declare the issue unethical.

The most frequent argument is that calling Trump mentally ill, and deriving from that judgment the conclusion that he is therefore unfit to serve in the White House, will stigmatize mentally ill people. Yet every sane person knows that there are as many varieties of mental illness as there are varieties of what passes for mental health—and that sometimes the line between the two is blurry, arbitrary, or downright illusory. And who among us is so certain of his or her own sanity not to doubt it from time to time?

As cavalier as this may sound, mental illness does not need to be professionally diagnosed. We don’t need to be told by a doctor that the guy who is coughing and sneezing at the other end of the train car is probably sick, though we don’t know if it is a cold, the flu, bronchitis, pneumonia, or an allergy. All we know is that the safe thing to do is to stay away from him. When someone is compulsively lying, continuously contradicting himself, imploring the approval of people even as he is attacking them, exalting people one day and abusing and vilifying them the next, then the question of his mental state is moot. The safe thing to do is not just to stay away from him, but to keep him away from situations where he can do harm.

In a different set of circumstances, it would be better for the press to ignore the question of a president’s mental fitness altogether. But this is not a normal set of circumstances. There is not necessarily, to use what has become an obnoxious buzz phrase, a “new normal.” There is either a shift from what we are used to that occurs within the boundaries of what is rationally and morally acceptable, or there is a shift from what we are used to that occurs outside those boundaries. We are now in the latter situation. It is new, but it is anything but normal.

If you watched Trump’s news conference last Thursday and thought, “This is Trump talking” then you would not have been sensitive to the profound transformation in the country that has occurred beneath all the distracting upheavals. But if you watched from a distance, as it were, thinking, “This is the American president talking,” then you would have been alarmed in a new kind of way.

The mental condition of the president of the United States is as legitimate a subject of journalistic concern as it is of everyday conversation.

Psychiatrists can and should argue about whether they should speculate publicly about Trump’s mental state. But it would be a mistake to marginalize that issue by specializing it and leaving it to the psychiatrists. The mental condition of the president of the United States is as legitimate a subject of journalistic concern as it is of everyday conversation.

No journalist or editor needs to be told that there is both cause and justification for addressing the question of Trump’s mental condition. Everyone knows that, if the question were addressed in a systematic way, it would have to be done in the kind of detached, objective, rational manner that would give it credibility. Especially in the current moment, when Trump has turned the press into an automatic scapegoat for his own missteps, the media would have to be very careful how it raised the subject.

Op-eds questioning Trump’s sanity would have to be counterbalanced by op-eds asserting his sanity; reporters recording doubts about Trump’s sanity among ordinary people as well as politicians and former statesmen would have to present opposing opinions; editorials concluding that he is mentally unfit to be president would have to acknowledge the arguments against and the perils of saying so, and the possible ensuing consequences.

The manner in which the question of Trump’s mental health has to be handled once it is raised is obvious, of course. The more contentious question has been whether to raise it, and to keep raising it. At this point, not to do so, especially for journalists, is a betrayal of the public trust, a denial of human nature, and an insult to posterity.